Alert If the patient is pregnant, antibiotics must be prescribed cautiously.
Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days. Follow-up treatment may include reculturing urine 1 week after drug therapy stops, then periodically for the next year to detect residual or recurring infection. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.
In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk of recurring urinary tract and kidney infections, such as those with prolonged use of an indwelling catheter or maintenance antibiotic therapy, require long-term follow-up. Recurrent episodes of acute pyelonephritis can eventually result in chronic pyelonephritis. (See Chronic pyelonephritis.)
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Nephrotic syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The goals of treatment of nephrotic syndrome are to relieve symptoms, prevent complications, and delay progressive kidney damage. Treatment of the causative disorder — possibly lifelong — is necessary to control nephrotic syndrome. Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may help control symptoms. Antibiotics may be needed to control infections. Angiotensin-converting enzyme inhibitors may significantly reduce the degree of protein loss in urine and are therefore typically prescribed for the treatment of nephrotic syndrome.
Treatment of hypertension and of high cholesterol and triglyceride levels are also recommended to reduce the risk of atherosclerosis and complications. Dietary limitation of cholesterol and saturated fats may be of little benefit because the high levels that accompany this condition seem to result from overproduction by the liver rather than from excessive fat intake. High-protein diets are of debatable value. In many patients, reducing the amount of protein in the diet produces a decrease in urine protein. In most cases, a moderate-protein diet (1 g/kg of body weight per day) is usually recommended. Sodium may be restricted to help control edema. Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy. Blood thinners may be required to treat or prevent clot formation.
Supportive treatment consists of protein replacement with infusion of salt-poor albumin or with a nutritional diet of 1.5 g protein/kg of body weight, with restricted sodium intake of 0.5 to 1 g/day; diuretics for edema; and antibiotics for infection.
Some patients respond to an 8-week course of corticosteroid therapy (such as prednisone), followed by a maintenance dose. Others respond better to a combination course of prednisone and azathioprine or cyclophosphamide.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Acute poststreptococcal glomerulonephritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The goals of treatment are relief of symptoms and prevention of complications. Vigorous supportive care includes bed rest, fluid and dietary sodium restrictions, and correction of electrolyte imbalances (possibly with dialysis, although this is rarely necessary). Therapy may include diuretics to reduce extracellular fluid overload and an antihypertensive. The use of antibiotics is recommended for 7 to 10 days if staphylococcal infection is documented. Otherwise, antibiotic use is controversial.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic glomerulonephritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is essentially nonspecific and symptomatic, with its goals to control hypertension with antihypertensives and a sodium-restricted diet, to correct fluid and electrolyte imbalances through restrictions and replacement, to reduce edema with diuretics such as furosemide, and to prevent heart failure. Treatment may also include antibiotics (for symptomatic urinary tract infections [UTIs]), dialysis, or transplantation.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Hematuria:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nephrotic syndrome:
Treatment
(Handbook of Diseases)
Effective treatment of nephrotic syndrome necessitates correction of the underlying cause, if possible. Supportive treatment consists of protein replacement with a nutritional diet of 1 g protein/kg of body weight, with restricted sodium intake; a diuretic for edema; and an antibiotic for infection. Immunosuppressants, antihypertensives, and diuretics can also help control symptoms. Angiotension-converting enzyme inhibitors can decrease protein loss in urine.
Some patients respond to a course of corticosteroid therapy (such as prednisone), followed by a maintenance dose. Patients with chronic nephrotic syndrome that’s unresponsive to therapy may require vitamin D replacement.
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Source: Handbook of Diseases, 2003
Pyelonephritis, acute:
Treatment
(Handbook of Diseases)
Effective treatment centers on antibiotic therapy appropriate to the specific infecting organism after identification by urine culture and sensitivity studies.
Antibiotic therapy
I.V. antibiotics are used initially to control bacterial infection. Chronic pyelonephritis may require long-term antibiotic therapy. Commonly used antibiotics include sulfa drugs, amoxicillin, cephalosporins, levofloxacin, and ciprofloxacin. If the patient is pregnant, antibiotics must be prescribed cautiously. Urinary analgesics such as phenazopyridine are also appropriate.
Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days.
Follow-up treatment
Follow-up treatment includes reculturing urine after drug therapy stops. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.
CLINICAL TIP: In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk for recurring urinary tract and kidney infections — such as those with prolonged use of an indwelling urinary catheter or maintenance antibiotic therapy — require long-term follow-up.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Glomerulo-nephritis, acute poststreptococcal:
Treatment
(Handbook of Diseases)
The goals of treatment are relief of symptoms and prevention of complications. Vigorous supportive care includes bed rest, fluid and dietary sodium restrictions, and correction of electrolyte imbalances (possibly with dialysis, although this is seldom necessary).
Therapy may include diuretics, such as metolazone and furosemide, to reduce extracellular fluid overload and an antihypertensive such as hydralazine. The use of antibiotics to prevent secondary infection or transmission to others is controversial.
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Source: Handbook of Diseases, 2003
Glomerulo-nephritis, chronic:
Treatment
(Handbook of Diseases)
Effective treatment, essentially nonspecific and symptomatic, aims to control hypertension with antihypertensives and a sodium-restricted diet, to correct fluid and electrolyte imbalances through restrictions and replacement, to reduce edema with diuretics such as furosemide, and to prevent heart failure.
Treatment may also include antibiotics (for symptomatic urinary tract infections), dialysis, and transplantation.
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Source: Handbook of Diseases, 2003
Hematuria:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination. Encourage the patient to drink plenty of fluids, unless contraindicated.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hematuria:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Check vital signs frequently.
▪ Monitor intake and output, including the amount and pattern of hematuria.
▪ If the patient has an indwelling urinary catheter in place, ensure its patency and irrigate it if necessary to remove clots and tissue that may impede urine drainage.
▪ Administer prescribed analgesics, and enforce bed rest as indicated.
▪ Prepare the patient for diagnostic tests, such as blood and urine studies, cystoscopy, and renal X-rays or biopsy.
▪ Monitor hemoglobin level and hematocrit; administer blood products as ordered.
Patient teaching
▪ Show the patient how to collect urine specimens.
▪ Emphasize the need to increase fluid intake.
▪ Explain the underlying cause of hematuria and its treatment.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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